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Treatment of functional chest pain with antidepressants: a meta-analysis
Wen Wang1, Yong-Hai Sun, Ya-Yu Wang
1Department of Anatomy, Histology and Embryology, K.K. Leung Brain Research Centre, the Fourth Military Medical University, No. 169 West Chengle Road, Xi'an, China.
Insights
Antidepressants effectively reduce pain and psychological distress in functional chest pain patients. Further research is needed to explore factors influencing treatment outcomes.
Area of Science:
- Cardiology
- Psychiatry
- Clinical Pharmacology
Background:
- Recurrent functional chest pain (FCP) with normal coronary anatomy is a common condition.
- It often lacks identifiable gastroenterological or respiratory causes, leading to potential overuse of medical care.
- Antidepressant treatment efficacy for FCP remains an area of investigation.
Purpose of the Study:
- To conduct a meta-analysis evaluating the effectiveness of antidepressant treatments for functional chest pain (FCP).
- To synthesize evidence from randomized controlled trials (RCTs) on antidepressant use in patients with FCP and normal coronary anatomy.
Main Methods:
- Searched major databases (MEDLINE, PsycINFO, Scopus, CENTRAL) up to July 2011.
- Included RCTs assessing any antidepressants for FCP with normal coronary anatomy.
- Utilized standardized mean differences (SMDs), weighted mean differences (WMDs), and odds ratios (ORs) for effect summarization.
Main Results:
- Seven RCTs with 319 participants were analyzed.
- Strong evidence indicated antidepressants reduce pain (SMD -1.26) and psychological symptoms (SMD -0.87).
- Increased side effects were observed (OR 0.34), with no significant improvement in quality of life.
Conclusions:
- Antidepressant medications show promise in alleviating pain and psychological symptoms associated with FCP.
- Limitations include unreported participant demographics and co-medications, hindering heterogeneity analysis.
- Further studies should investigate the impact of psychiatric comorbidity, gender, age, ethnicity, and treatment duration on outcomes.
Background:
Recurrent Functional Chest pain (FCP) with normal coronary anatomy and no detectable gastroenterological and respiratory causes is a common problem that sometimes leads to excess use of medical care.
Objective:
The purpose of this meta-analysis is to investigate the efficacy of antidepressant treatments for FCP.
Settings:
MEDLINE, PsycINFO, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched up to July 2011. Randomized controlled trials (RCTs) that tested any type of antidepressants for FCP with normal coronary anatomy were analyzed. Diagnoses included non-specific chest pain, noncardiac chest pain, atypical chest pain, syndrome X, or chest pain with normal coronary anatomy.
Methods:
Two authors independently extracted data. Effects were summarized using standardized mean differences (SMDs), weighed mean differences (WMD), or odds ratio (OR) by suitable effects model.
Results:
Seven RCTs (median duration, 5 weeks; range, 3 - 16 weeks) involving 319 participants were included. There was strong evidence for an association of antidepressants with reduction in pain (SMD -1.26; 95% confidence interval [CI], -2.34 to -0.19) and psychological symptoms (SMD -0.87; 95% CI, -1.67 to - 0.08) as well as increased side effects (OR 0.34; 95% CI, 0.15 to 0.78). Current analysis did not support the association of antidepressants with improved health related quality of life (WMD 2.00; 95% CI, - 2.54 to - 6.65).
Limitations:
Demographics, co-morbidities of study participants and the amount of co-medication were not reported, these possible sources of heterogeneity could not be examined.
Conclusions:
Antidepressant medications are associated with improvements in pain and psychological symptoms. The effects of factors including psychiatric co-morbidity, gender, age, ethnic group, and treating period on the outcomes should be checked further.
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